Sempokuya Tomoki, Patel Kishan P, Azawi Muaataz, Ma Jihyun, Wong Linda L
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States.
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States.
World J Clin Cases. 2021 Aug 16;9(23):6734-6746. doi: 10.12998/wjcc.v9.i23.6734.
The incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in the United States. However, the increases in different racial and socioeconomic groups have not been homogeneous. Access to healthcare based on socioeconomic status and cost of living index (COLI), especially in HCC management, is under characterized.
The aim was to investigate the relationship between the COLI and tumor characteristics, treatment modalities, and survival of HCC patients in the United States.
A retrospective study of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HCC between 2007 and 2015 using site code C22.0 and the International Classification of Disease for Oncology, 3rd edition (ICD-O-3) codes 8170-8173, and 8175. Cases of fibrolamellar HCC were excluded. Variables collected included demographics, COLI, insurance status, marital status, stage, treatment, tumor size, and survival data. Interquartile ranges for COLI were obtained. Based on the COLI, the study population was separated into four groups: COLI ≤ 901, 902-1044, 1045-1169, ≥ 1070. The test was used to compare categorical variables, and the Kruskal-Wallis test was used to compare continuous variables without normal distributions. Survival was estimated by the Kaplan-Meier method. We defined < 0.05 as statistically significant.
We identified 47,894 patients with HCC. Patients from the highest COLI areas were older (63 61 years of age), more likely to be married (52.8% 48.0%), female (23.7% 21.1%), and of Asian and Pacific Islander descent (32.7% 4.8%). The patients were more likely to have stage I disease (34.2% 32.6%), tumor size ≤ 30 mm (27.1% 23.1%), received locoregional therapy (11.5% 6.1%), and undergone surgical resection (10.7% 7.0%) when compared with the lowest quartile. The majority of patients with higher COLIs resided in California, Connecticut, Hawaii, and New Jersey. Patients with lower COLIs were more likely to be uninsured (5.7% 3.4%), have stage IV disease (15.2% 13%), and have received a liver transplant (6.6% 4.4%) compared with patients from with the highest COLI. Median survival increased with COLI from 8 (95%CI: 7-8), to 10 (10-11), 11 (11-12), and 14 (14-15) mo ( < 0.001) among patients with COLIs of ≤ 901, 902-1044, 1045-1169, ≥ 1070, respectively. After stratifying by year, a survival trend was present: 2007-2009, 2010-2012, and 2013-2015.
Our study suggested that there were racial and socioeconomic disparities in HCC. Patients from lower COLI groups presented with more advanced disease, and increasing COLI was associated with improved median survival. Future studies should examine this further and explore ways to mitigate the differences.
在美国，肝细胞癌（HCC）的发病率和死亡率呈上升趋势。然而，不同种族和社会经济群体的增长并不一致。基于社会经济地位和生活成本指数（COLI）获得医疗保健的情况，尤其是在HCC管理方面，目前特征尚不明确。
旨在研究美国HCC患者的COLI与肿瘤特征、治疗方式及生存之间的关系。
对监测、流行病学和最终结果（SEER）数据库进行回顾性研究，使用部位编码C22.0以及国际肿瘤疾病分类第3版（ICD - O - 3）编码8170 - 8173和8175，识别2007年至2015年间的HCC患者。排除纤维板层型HCC病例。收集的变量包括人口统计学资料、COLI、保险状况、婚姻状况、分期、治疗、肿瘤大小和生存数据。获取COLI的四分位数间距。根据COLI，将研究人群分为四组：COLI≤901、902 - 1044、1045 - 1169、≥1070。采用卡方检验比较分类变量，采用Kruskal - Wallis检验比较非正态分布的连续变量。采用Kaplan - Meier法估计生存情况。我们将P < 0.05定义为具有统计学意义。
我们识别出47,894例HCC患者。来自COLI最高地区的患者年龄较大（63岁对61岁），更可能已婚（52.8%对48.0%），女性比例更高（23.7%对21.1%），且亚太岛民后裔比例更高（32.7%对4.8%）。与最低四分位数组相比，这些患者更可能处于I期疾病（34.2%对32.6%）、肿瘤大小≤30 mm（27.1%对23.1%）、接受局部区域治疗（11.5%对6.1%）以及接受手术切除（10.7%对7.0%）。大多数COLI较高的患者居住在加利福尼亚州、康涅狄格州、夏威夷州和新泽西州。与COLI最高的患者相比，COLI较低的患者更可能未参保（5.7%对3.4%）、处于IV期疾病（15.2%对13%）以及接受肝移植（6.6%对4.4%）。COLI≤901、902 - 1044、1045 - 1169、≥1070的患者中位生存期随COLI增加，分别从8（95%CI：7 - 8）个月增至10（10 - 11）个月、11（11 - 12）个月和14（14 - 15）个月（P < 0.001）。按年份分层后，存在生存趋势：2007 - 2009年、2010 - 2012年和2013 - 2015年。
我们的研究表明，HCC存在种族和社会经济差异。COLI较低组的患者疾病进展更严重，COLI升高与中位生存期改善相关。未来研究应进一步对此进行研究，并探索缩小差异的方法。
